1. Were you arrested or charged with DUI/DWI? *

Yes

No

2. When did the arrest happen? *

Within 24 hours

Within 7 days

Within 30 days

More than 30 days

3. What county did the DUI happen in? *

Duval

St. Johns

4. Is this your first DUI offense? *

Yes

No

5. Did you take a breath test, blood test or perform a field sobriety test? *

Field Sobriety Test

Breath

Blood

Refuse

6. Has your driver’s license been suspended or confiscated? *

Yes

No

7. Have you already hired or spoken with another attorney? *

Yes

No

Will you be able to make the initial payment? *

Yes

No

How do you intend to pay the remaining balance? (optional)

Payment Plan

Full Name *

Phone *

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Email *

Briefly describe what happened (optional)

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